Identifying neuropathy in patients with mesh related pain

An observational study to determine pain outcomes following polypropylene mesh (PPM) removal surgery

  • Hospital – Speciality: Saint Mary’s – Urogynaecology
  • Study type: Observational
  • Funder: The Manchester Academic Health Science Centre (MAHSC)

Summary

In the UK over 100,000 women have had polypropylene mesh (PPM) inserted into the vagina and pelvis to treat urinary incontinence. Some women have developed chronic pain following mesh insertion. There is little evidence to determine how to treat the pain including whether surgical removal of mesh will help. It is possible that patients with chronic pain may have developed a change in the way their nerves and sensory system works called Central Sensitization (CS). This has occurred due to high levels of pain over a long period of time. This results in more sensitivity to pain and loss of sensation, due to damage to their nerves called Small Fibre Neuropathy (SFN). Patients with mesh who have pain may have developed SFN therefore removal of the mesh in these patients will not improve their pain as their nerve fibres have already been damaged.

This study aims to examine whether small nerve fibres in patients with mesh and pain are damaged and not functioning due to CS and SFN. This will be performed by using a technique called Corneal Confocal Microscopy (CCM) to take detailed images of these nerves in the front of the eye. By analysing these images, researchers can determine if the nerves are damaged and identify which patients may benefit from mesh removal surgery and those who will likely not.

Participant group 

All patients with Polypropylene Mesh (PPM) related pain and no other PPM complications who access the Manchester Mesh Complication Service (MMC).

Participant approach

Eligible patients will be identified by the Clinical Research Fellow, who is a member of the clinical care team, using notes of patients referred to the Manchester Mesh Complication Service (MMCS) with Polypropylene Mesh complications (PPM).

Pain-free patients will be identified from hospital records of patients who have had previous PPM insertion surgery at the hospital. Eligible patients will then be approached with written information about the study. This will be done face-to-face at clinic appointments, over the phone or through information sent in the post.

Study open date and expected length

Opened: 22 May 2024

Expected end date: December 2027

Results

Pending – this study is currently active.

Contact details

Email address: hawra.badri@mft.nhs.uk

  • IRAS number: 325787